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Contents

• Letter from the Editor Bo Peng
  
• Bioethics in the News Markley Foreman, Leila Glass, Tuua Ruutiainen
  
• Bioethical Issues Facing the Next President Sasha Riser-Kositsky
  
• Interview: Dr. Jesse Owens (University of Alaska)

Articles

• Hope and Autonomy in the Context of Heart Transplantation by Kaveh Ardalan, University of Virginia Read Abstract

  This article describes and problematizes the relationship between hope and autonomy. The author’s conversations with health care professionals and observations of patient-professional interactions throughout the course of a Fall 2004 clinical bioethics internship at the University of Virginia hospital provide the basis for the analysis and conclusions drawn. The author argues that the clinical experience of hope is not morally neutral. Specifically, experiences of hope and exercises of autonomy are often closely linked and in tension with one another. At the very least, false hopes should not be encouraged. However, even realistic hopes have ethically murky implications for autonomy. The negotiation of hope and autonomy should be considered a central issue in patient-professional relationships.

• The Ethical Consequences of Modafinil Use by Molly Cahill, University Of Pennsylvania Read Abstract

  Modafinil is a stimulant that is beginning to receive attention in the United States because it lacks the negative physical side-effects of traditional stimulants. While these side-effects were an impediment to widespread use of stimulants such as amphetamines, there is no such barrier to widespread use of modafinil, and a country as chronically sleep-deprived as the United States could be extremely receptive to this drug. The possibility of widespread use of a neurocognitive enhancer such as modafinil raises many ethical issues. For instance, sleep-deprivation is a serious problem in the United States but a drug that appears to be a near-perfect treatment for sleep-deprivation may compromise personal autonomy. Also, as is the case with all neurocognitive enhancers, modafinil raises issues surrounding the United States’ cultural concept of pharmacological Calvinism, according to which drugs should only be used to treat or cure illness and disease. Modafinil highlights conflicts between cultural values concerning effort, success, and the role of pharmaceuticals in the United States that will have to be resolved for the drug to assume a role in society.

• Wrongful Life and Wrongful Birth: Legal Aspects of Failed Genetic Testing in Oocyte Donation by Kristen N. Carey, Villanova University Read Abstract

  The field of reproductive medicine has all but exploded in recent years, allowing more people access to novel treatments. New technologies have been introduced so rapidly that ethics and the law have been unable to respond appropriately. A particularly promising reproductive therapy, oocyte donation, and the wide variety of prenatal genetic tests already available, will theoretically present the legal world with a variety of new challenges. How should the law respond to potential wrongful birth and wrongful life suits resulting from failed genetic testing, if the child in question was conceived using a donor egg? Under what circumstances should the physician be held liable? Under what circumstances might the donor be culpable? This paper reviews scholarly opinions and existing case law in order to answer these questions.

• The Real Death of Vitalism: Implications of the Wöhler Myth by Anthony M. Cheng, University of Pennsylvania Read Abstract

  There is a tendency for extraneous issues to unnecessarily complicate bioethical debate. Vitalism is one of these topics. The implications of the Wöhler Myth, a popular account of science’s victory over vitalism, are examined descriptively and normatively: I reflect on how the Myth’s prevalence shaped the attitudes of science and religion and evaluate those attitudes.

• Ethical Implications of Pharmacological Enhancement of Mood and Cognition by Michael F. Esposito, University Of Pennsylvania Read Abstract

  With advances in the molecular biology of neuroscience, there is an increased understanding of neurotransmitter systems and the biological basis of memory and mood. This has lead to the research and development of highly selective drugs that serve to alter the brain for treatment and enhancement. Many ethical concerns arise about the use of pharmacological agents to alter the brain solely for enhancement. Safety, alteration of personhood, distributive justice, and the medicalization of the human condition will be discussed. However, the potential to increase one’s memory and efficiency in the workplace, to eliminate socially undesirable behaviors, and to strengthen the military provides a strong argument in favor of pharmacological enhancement. In conjunction with the ethical concerns, this paper explores recent research and current and developing drugs, ultimately arguing that pharmacological enhancement is acceptable as long as certain policies are implemented.

• Clinical Research on the Subject with Dementia: Ethical Concerns and Research Regulation by Nina M. Mirarchi, University of Pennsylvania Read Abstract

  While today’s prospective research subjects enjoy a greater measure of autonomy than those from the past, investigators must continually strive to protect vulnerable populations, especially cognitively impaired older adults with dementia. Investigators should respect the person’s autonomy, while also considering the role of beneficence, nonmaleficence, and justice. The study’s risks must be weighed against the benefits, and researchers should obtain their subjects’ informed consent. Since competence and capacity tests do not always yield conclusive assessments of cognitive function, however, proxy decision-makers are sometimes appointed. Such a framework is problematic. Not only may proxy decision makers misinterpret the subjects’ wishes, but they may also ignore them altogether. In addition, some institutional review boards have recently been criticized for failing to protect research subjects. While various commissions have addressed some bioethical concerns, controversy remains over whether research on adults with dementia is ethical given the vulnerability of these subjects to exploitation.

• “Soft” Science in the Courtroom?: The Effects of Admitting Neuroimaging Evidence into Legal Proceedings by Bridget Pratt, Haverford College Read Abstract

  There is an ongoing debate regarding the proper standards for admitting neuroimaging evidence into legal proceedings. At present, neuroimages are increasingly being introduced as part of psychiatric testimony. In courtrooms, however, the idea that two visibly different brain scans offer proof of insanity has become increasingly conventional. This becomes a problem for the criminal justice system because by understanding neuroimaging evidence in such a manner, jurors fundamentally misinterpret it. Furthermore, given the mechanical objectivity associated with neuroimages, jurors' erroneous inferences are then afforded undue weight in their assessments of defendants' mental states. Lawyers are now able to convey that their clients weren't rational when they committed their crimes simply by showing jurors two dissimilar neuroimages. In order to mitigate the prejudicial effects of such evidence, it is, therefore, imperative that a new neuroimaging evidence admissibility standard be adopted by the American legal system.

• Euthanasia and Physician Assisted Suicide: Effect on the Doctor-Patient Relationship by Nadine Spigel, University of Pennsylvania Read Abstract

  The subjects of euthanasia and physician-assisted suicide (PAS) serve as controversial topics, not only in the United States, but all around the world. Euthanasia, defined as “the hastening of death of a patient to prevent further sufferings,” has different forms. These include: voluntary euthanasia, involuntary euthanasia, and non-voluntary euthanasia, as well as active and passive euthanasia. Physician-assisted suicide involves the physician providing a means in which a patient can end his life. Many arguments, both positive and negative, have surfaced concerning how the discussion of euthanasia and physician-assisted suicide effect the doctor-patient relationship. Upon examining both sides closely, the open discussion of euthanasia and patient-assisted suicide between the doctor and patient is beneficial, as it will improve both the doctorpatient relationship, as well as the quality of care the doctor is able to provide for the patient.

• Pediatric Cochlear Implants: The Great Debate by Aviva Weinberg, University Of Pennsylvania Read Abstract

  The rise and refinement of the cochlear implant, a device meant to correct for sensorineural hearing loss in prelingually deaf children, has faced much debate and criticism. The controversy over this corrective technology has revealed a significant social divide between the hearing and the non-hearing parents of these deaf children. While the hearing parents welcome the implant as an exciting new medical remedy for their children’s deafness, the nonhearing parents reject the implant as a tool of discrimination. The source of this divide seems to lie in two very different operative paradigms for deafness: the pathological and the sociocultural. The hearing parents’ pathological view places deafness as an auditory deficit meant to be repaired, while the non-hearing parents view deafness as a sociocultural identity. Understanding these divergent social perspectives sheds light on the heavy controversy surrounding the cochlear implant and its hopes for future use.

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